Application Number :
LOURDES MATHA COLLEGE OF SCIENCE & TECHNOLOGY
Lourdes Hills, Kuttichal P O, Thiruvanathapuram – 695574 | Phone : 0472-2853550 / 2853546
Fax : 0472-2853846 | E-mail : [email protected] | Website : www.lmcst.ac.in | City office : 0471-2302481
Minority Status Educational Institution | Approved by AICTE & Affiliated to the Kerala Technological University
Member of Kerala Catholic Engineering College Managements' Association
Managed by Lourdes Matha Catholic Educational Society
An ISO 9001-2008 certified
institution
APPLICATION FORM FOR ADMISSION TO B.TECH LATERAL ENTRY SCHEME 2015- '16
Allotment code
:
DD/Cash Receipt No :
LMC
Dated
:
Affix a recent stamp
size photograph of the
Applicant
( Fill in Block Letters or Tick wherever is applicable)
(Do not Staple)
01. NAME OF APPLICANT
(As entered in 10th certificate)
02. DATE OF BIRTH
D
D
04. RELIGION
M
M
Y
Y
Y
03. GENDER
Y
M
F
05. CASTE
06. COMMUNITY
Permanent
Communication
07. ADDRESS
PIN
PIN
08. PHONE NUMBER
09. E-MAIL ID
10. FATHER’S NAME
OCCUPATION
11. MOTHER’S NAME
OCCUPATION
12. NATIONALITY
13. ANNUAL FAMILY INCOME
14. DETAILS OF EDUCATIONAL QUALIFICATIONS (SSLC/HSE/CBSE/ISC/OTHERS)
EXAM
[ Kerala
BOARD
COURSE
YEAR OF PASSING
HSE/CBSE/ISC/VHSC/
Others (specify) ]
X
XII
NAME OF
INSTITUTION
PERCENT
AGE OF
MARKS
15. DETAILS OF QUALIFYING EXAMINATION (DIPLOMA / OTHERS) :
COURSE UNDERGONE
NAME OF INSTITUTION
BOARD / UNIVERSITY
16. KERALA LATERAL ENTRY ENTRANCE EXAMINATION DETAILS
REGISTER NUMBER
LET RANK
17. MARKS/ PERCENTAGE PER SEMESTER OF DIPLOMA EXAMINATIONS
SEMESTER
PERCENTAGE
GPA
SEMESTER
S1
S2
S3
S4
S5
S6
PERCENTAGE
GPA
18. BRANCH OPTED
DECLARATION BY THE APPLICANT
I, …………………………………………………… solemnly declare that the details furnished are true. I also
undertake that any wrong information furnished by me will forfeit my claim for admission. I will obey the rules and regulations of
the instituion, if admitted. I shall submit all certificates and documents in original at the time of admission, failing which my
admission will be liable for cancellation.
I shall not resort to ragging in any form at any place and shall abide by the rules/laws prescribed by Courts,
Governments, affiliating University & College authorities for the purpose from time to time.
Place
:
Date
:
Name & Signature of the Applicant
DETAILS OF TRUE COPIES TO BE SUBMITTED ALONG WITH THE APPLICATION
1 SSLC/ Equivalent Certificate.
2 Marklist of +2/CBSE/ISC.
3 Mark list of qualifying Examination & Certificate.
4 Admit card & Score card of Entrance examination (LET - 2015).
5 For downloaded application, a DD of Rs 500/- drawn in favour of Principal, LMCST payable at Trivandrum.
6 Certificate from the parish priest in the case of christian community.
FOR OFFICE USE ONLY
Certificates verified
Fees paid
Rs : …………………
Name and Signature of the Office Superintendent
Admission No. :
Admission Granted / Rejected
Date of Admission :
Orders of Director / Principal